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Date run 1/8/01 9:35:02AM Se <br />Run by . LBROWN <br />Record Selection Criteria: Facility ID FA0006687 <br />OWNER FILE INFORMATION <br />JOAQUIN COUNTI PUBLIC HEALTH F ,/ =S <br />Facility Information as of 1/8/01 <br />Record ID <br />Owner ID: <br />OW0000596 <br />Owner Name: <br />WALMART, INC <br />Owner DBA: <br />WALMART #1840 <br />Owner Address: <br />702 W EIGHTH ST DEPT 8013 <br />Phone: <br />BENTONVILLE, AR 72716 - <br />Home Phone: <br />209-368-2194 <br />Work/Bussness Phone: <br />209-368-2194 <br />Mailing Address: <br />702 W EIGHTH ST DEPT 8013 <br />BENTONVILLE, AR 72716 - <br />Care of: <br />WALMART. INC <br />FACILITY FILE INFORMATION <br />Facility ID: <br />FA0006687 <br />Facility Name: <br />WALMART #1554 <br />Location: <br />3702 E HAMMER LN <br />STOCKTON, CA 95212 <br />Phone: <br />209-473-2796 <br />Mailing Address: DEPT 8013 <br />BENTONVILLE, AR 72716-8013 <br />Care of: ANGELA WISE, LIC DEPT <br />Location Code: 01 - STOCKTON <br />BOS District: 002 - MARENCO, DARIO <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID: AR0009046 <br />Mail Invoices to: Facility <br />Account Name: WALMART #1554 <br />Account Balance as of 1/8/01: $0.00 <br />Report # : 0002 <br />Paae # 1 <br />ELMO <br />Make changes/corrections in RED ink or pencil. <br />INFORMATION CHANGE (date) <br />OWNERSHIP CHANGE (date) <br />New Owner ID <br />APN: <br />SIC Code: <br />New Account ID:: <br />Mail Invoices to: Owner / Facility / Account <br />(Circle One) <br />(Circle One <br />UST(s) Transfer to Active/Inacty <br />Program/Element and Description Record ID Employee ID and Name Status Linked New Owner? Delete <br />2361 - NEW MULTI UST FACILITY PR0504432 EE0000451 - SASSON Inactive 5 Y N I <br />1615 - RETAIL MKT <2000 SQ FT (PREPKGD ONLY PR0505294 EE0000321 - OLIVEIRA Active Y N I <br />2233 - HAZARDOUS WASTE CESQT FACILITY PRO506905 EE0000418 - KITH Inactive Y N <br />2213 - HAZ WASTE CE FAC STATE SERVICE FEE PR0506906 EE0000418 - KITH Inactive Y N I <br />2399 - UNIFIED PROGRAM FAC STATE SERVICE F PR0506907 EE0000418 - KITH Inactive Y N <br />12�20 S rn.a..P 2-- L t l�r� tS'� pp'o `�IA '711 (,,, . a-- rk <br />BILLING and COMPLIANCE ACKNOWLEDGEMENT. • I, the undersigned owner, operator or agent of same, acknowledge that all site, anrUor pro/'eel <br />specific, PHidentified <br />S/EHD hourly charges associated with this facility or activity will be billed to the party as the BILLING PARTY on this farm / <br />also certify that all operations will be performer/ in accordance with all applicable Ordinate Codes an or Standards and State ancUor Federal Laws <br />APPLICANT'S SIGNATURE: Date <br />Program Records to be TRANSFERED: $0.00 = Amount Paid Date <br />Water System to be TRANSFERED ' $150.00 = Amount Paid Date—/—/ <br />Payment Type ,�eck Number Receipt Number Received by <br />RENS: Date / Account out: Date 0/ /-09'/ D / <br />1.0.0.89.00 <br />